1. Field of the Invention
The invention provides a pressure dressing for the treatment of lymphoedema.
2. Background Art
Lymphoedema is a condition caused by obstruction of the lymphatic system in the body. It is the lymphatic system which is responsible for draining the spaces between cells of the body, ridding those spaces of excess fluid. The lymphatic system is a circulatory system entirely separate from that of the bloodstream. Where there is lymphatic obstruction there is a swelling of the associated patient limb, with the exudates being protein-rich, unlike non-lymphatic oedemas where the exudate is generally protein-depleted.
Chronic lymphoedema is a common side-effect of the surgical treatment for breast cancer in which lymph nodes are dissected as part of the surgical procedure. Additionally, radiotherapy which is used routinely in breast cancer treatment can damage the lymphatic function. The treatment of breast cancer is not however the sole cause of lymphoedema. There is an inherited condition, Milroy""s Disease, which is responsible for poorly developing lymphatics. Obstruction of the lymphatic channels can also be caused by cancer, by scar tissue, by the historical removal of lymph nodes or by fibrosis caused by X-ray therapy.
Lymphoedema can occur in any of the limbs of a patient, although it is most common for it to be present in the arms as opposed to the legs. The recognized treatment is the application of pressure over the whole of the limb. The pressure expresses the lymphatic fluid from the inter-cellular spaces. Considerable pressure can be applied, so long as it is applied uniformly over the limb. As a generality, the accumulated lymphatic fluid in the limb protects the patient""s blood vessels from collapse due to excessive pressure, so the patient""s blood flow is not adversely affected by the use of a tight compression dressing.
It has been proposed to apply the necessary pressure on the limb by means of a compression dressing comprising an inflatable sleeve. The inflatable sleeve can however be applied only when the patient is lying prone, and the inflation mechanism and the means for monitoring the pressure applied render the device wholly non-portable. The usual treatment for lymphoedema is therefore not the use of such a sleeve but the process of bandaging the limb with a tightly wound elasticated bandage. That however is something which requires skill and experience, and cannot be done by the patient alone.
The object of this invention is to provide a compression dressing for the treatment of lymphoedema which can be applied safely and reliably by the patient unaided.
The invention provides a compression dressing for the treatment of lymphoedema, comprising
a panel of elastically stretchable material of a size sufficient to wrap once around a patient""s limb with some overlap, the outer surface of the panel having a loop pile structure; and
a separable slide fastener comprising two rows of inter-engageable teeth mounted on two separate tapes, one of the tapes being secured to one longitudinal edge of the panel and the other of the tapes being secured to an anchorage element which comprises a number of mutually spaced fabric tabs each having on an under surface hooks for anchoring the anchorage element to the loop pile structure of the panel.
The invention also provides a method of applying such a dressing to a limb, comprising measuring the circumference of the limb at a number of mutually spaced locations; using these measurements to anchor the said other of the tapes to the panel along a line corresponding to the desired degree of compression; connecting together a first end portion of the separable slide fastener; placing the connected end of the panel around the limb and closing the slide fastener to wrap the dressing around the limb with the desired degree of compression. Such a method can be carried out by the patient without nursing assistance, which is a great step forward over conventional bandage-wrapping techniques.
Lymphoedema is most commonly encountered in connection with the arms of patients, and for illustrative purposes only the remainder of this specification will make reference to arm dressings only. The reader will readily understand how the teachings can be modified to be pertinent to leg dressings.
The panel preferably has a cuff portion extending beyond the slide fastener tapes, to surround the hand of the patient. An oval thumb-hole is generally provided in this cuff portion, so that when the first end portion of the slide fastener is connected together so as to draw that cuff portion into a generally tubular configuration, the patient can insert his wrists through the tubular end with his thumb through the thumb-hole. The thumb-hole anchors the dressing at the wrist as the slide fastener is closed. Advantageously the ends of the cuff portion are themselves connectable together by the mating parts of a hook-and-pile fastener to maintain the cuff tight around the patient""s hand. It has been suggested that a pressure pad may advantageously be provided, to locate across the patient""s palm, to extend the pressure of the dressing to the palm as well as to the back of the hand.
The separable slide fastener is the type of fastener commonly available under the Trade Mark xe2x80x9cZIPxe2x80x9d fastener, and is of the type where the two tapes, each carrying its own row of metal or plastic teeth, can be completely separated. A slide connection is generally provided at one end of the slide fastener for establishing initial inter-engagement between the teeth prior to drawing a slide along the two rows of teeth to draw all teeth into mutually locking inter-engagement.
The loop pile structure of the outer surface of the panel and the hooks of the under surface of the tabs of the anchorage element form the two elements of a conventional hook-and-pile fastening system which is commercially available under the Trade Mark xe2x80x9cVELCRO xe2x80x9d. Preferably the loop pile structure is provided over the whole of the outer surface of the panel.
The panel is preferably of 2-way stretch material. Neoprene foam sheeting is very suitable, of the kind used in divers"" wetsuits. Such material has to be perforated to make it permeable. The optimum thickness of a neoprene foam sheet can be determined by trial and error, and will be dependent on the quality of the rubber. Sheets of thickness 2 mm or 3 mm may be suitable, depending on the modulus of elasticity. Alternatively the panel may be made from a suitable elastic knitted or woven stretch material.